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General NPI Number Information
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NPI Number | 1245494814
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Entity Type | Organization
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Legal Business Name | LA DENTAL URGENT CARE LLC
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Dates
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Enumeration Date | 07/14/2008
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 4021 W. E. HECK CT I-L
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City | BATON ROUGE
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State | LA
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Zip | 70816
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Country | US
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Telephone | 225-926-0702
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Fax | 504-218-4204
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Provider Business Mailing Address
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Address Line | 3121 MARYLAND AVE
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City | KENNER
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State | LA
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Zip | 70065
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Country | US
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Telephone | 504-390-2847
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Fax | 504-218-4204
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Authorized Official
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Title or Position | MANAGING MEMBER OF LLC/OWNER/PROVID
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Name | MISS JACLYN DUBOUE
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Credential | D.D.S.
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Telephone | 225-926-0702
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5635
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License Number State | LA
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